A COMPARATIVE STUDY BETWEEN OPIOID-FREE GENERAL ANAESTHESIA AND OPIOID-BASED GENERAL ANAESTHESIA ON THE QUALITY OF RECOVERY IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC HYSTRECTOMY: A Randomized Trial
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
This prospective randomised controlled study aims to evaluate the effects of opioid-free anaesthesia (OFA) compared with conventional opioid-based anaesthesia (OBA) in adult patients undergoing elective surgery under general anaesthesia. Eligible patients will be randomly assigned into two equal groups. The OFA group will receive a multi modal opioid-free anaesthetic regimen consisting of dexmedetomidine, ketamine, and lidocaine administered as loading doses followed by continuous infusions. The OBA group will receive fentanyl-based anaesthesia according to a standardised protocol. Both groups will receive similar induction agents, muscle relaxants, anti emetic prophylaxis, and postoperative analgesic regimens.
Preoperative hemodynamic parameters, including heart rate and blood pressure, will be recorded intraoperatively and during the postoperative period. Postoperative recovery will be assessed using the SAMPE recovery room discharge checklist(Stability, Awake and Oriented, Motor, Pain, and Emesis) recovery room discharge checklist, an eight-item score assessing vital signs stability, level of consciousness, spontaneous ventilation, oxygen saturation, pain control, absence of nausea and vomiting, absence of bleeding, and absence of motor block. Patients will be discharged from the post-anaesthesia care unit (PACU) upon achieving a SAMPE score of 8.. Pain intensity will be evaluated using the Visual Analogue Scale (VAS) at predetermined postoperative time points (0, 1, 6, and 12 hours). The incidence and severity of postoperative nausea and vomiting (PONV) during the first 24 postoperative hours will be recorded and graded using a standardised PONV severity score. Additional outcomes include time to first rescue analgesia, total postoperative opioid consumption, and the occurrence of opioid-related adverse events such as postoperative hypoxemia.
Furthermore, serum interleukin-6 (IL-6) levels will be measured preoperative, immediately after skin incision, and at 6 and 12 hours after induction of anaesthesia as a biomarker of the surgical stress response. The study seeks to determine whether opioid-free anaesthesia can improve postoperative recovery, reduce PONV and opioid requirements, and attenuate the preoperative stress response compared with conventional opioid-based anaesthesia.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: yomna emad Youssef, MBBCH
- Telefonnummer: 01026616629
- E-mail: yomnaelsayed@med.asu.edu.eg
Undersøgelse Kontakt Backup
- Navn: yomna emad youssef, MBBCH
- Telefonnummer: 01145211869
- E-mail: yomnayoussef95@gmail.com
Studiesteder
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Abbasia
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Cairo, Abbasia, Egypten, 00202
- Ain Shams
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Undergoing a scheduled laparoscopic hysterectomy surgery under general anaesthesia.
- Age group: 40-65 years old.
- BMI<35.
- ASA I-II.
Exclusion Criteria:
- Emergency hysterectomy.
- Allergy to any of the drugs used in the study.
- HR < 50 bpm (chronic treatment by beta blockers, heart block patients).
- Alcohol or drug abuse.
- Psychiatric disease.
- Liver impairment. Kidney impairment
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Dobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Aktiv komparator: Opioid-Based Anaesthesia (OBA)
Participants will receive conventional fentanyl-based anaesthesia during surgery in addition to standardized general anaesthesia.
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Fentanyl will be administered intravenously as the opioid component of balanced general anaesthesia. Loading dose of 2 mic/kg I.V. followed by continuous infusion of three syringes, one with fentanyl infusion 0.5mic/kg/hr, and two syringes with normal saline. will receive IV acetaminophen (1 g) and ketrolac 30mg 10 minutes before incision closure. Postoperative Analgesia: All patients will receive IV acetaminophen 1 g /8h, ketrolac 30 mg/8h and rescue doses of pethideine 0.5 mg/kg IM if VAS score is ≥ 4. |
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Aktiv komparator: Opioid-Free Anaesthesia (OFA) Group
Participants will receive opioid-free anaesthesia consisting of dexmedetomidine, ketamine, and lidocaine administered as loading doses followed by continuous intravenous infusions during surgery, in addition to standardized general anaesthesia.
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Dexmedetomidine: Loading dose of 1 µg/kg IV over 10 min before induction, followed by continuous infusion at 0.4 µg/kg/h . Ketamine: Loading dose of 0.25mg/kg followed by continuous infusion of ketamine at 0.1mg/kg/hr . Lidocaine: loading dose of 1.5mg/kg/hr followed by maintainance of 1mg/kg/hr. All three infusions to be stopped 30 minutes before skin closure will receive IV acetaminophen (1 g) and ketrolac 30mg 10 minutes before incision closure. Postoperative Analgesia: All patients will receive IV acetaminophen 1 g /8h, ketrolac 30 mg/8h and rescue doses of pethideine 0.5 mg/kg IM if VAS score is ≥ 4. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Incidence and Severity of Postoperative Nausea and Vomiting (PONV)
Tidsramme: Within the first 24 hours postoperative.
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Assessment of the incidence and severity of postoperative nausea and vomiting using a standardized PONV severity score.
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Within the first 24 hours postoperative.
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Postoperative Pain Score
Tidsramme: At 0, 1, 6, and 12 hours postoperative.
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Assessment of postoperative pain using the Visual Analogue Scale (VAS).
minimum better score 0 maximum worse score 10.
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At 0, 1, 6, and 12 hours postoperative.
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Time to First Rescue Analgesia
Tidsramme: Within the first 24 hours postoperative.
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Time elapsed from the end of surgery until the patient requires the first rescue analgesic.
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Within the first 24 hours postoperative.
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Total Postoperative Opioid Consumption
Tidsramme: Within the first 24 hours postoperative .
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Total amount of rescue opioid analgesics administered after surgery.
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Within the first 24 hours postoperative .
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Post-Anaesthesia Recovery Score SAMPE(score of ambulatory patients in the recovery room )
Tidsramme: perioperative
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Assessment of recovery using the SAMPE(score of ambulatory patients in the recovery room ) discharge checklist evaluating vital signs stability, level of consciousness, spontaneous ventilation, oxygen saturation, pain control, absence of nausea and vomiting, absence of bleeding, and absence of motor block minimum worse score 0 maximum better score 8 .
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perioperative
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Prioperative Hemodynamic Parameters
Tidsramme: Intraoperatively and during the immediate postoperative period.
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Assessment of heart rate changes during and after surgery.
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Intraoperatively and during the immediate postoperative period.
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Serum Interleukin-6 (IL-6) Levels
Tidsramme: Preoperative, immediately after skin incision, and at 6 and 12 hours after induction of anaesthesia.
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Measurement of serum IL-6 concentration as a biomarker of the perioperative stress response.
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Preoperative, immediately after skin incision, and at 6 and 12 hours after induction of anaesthesia.
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Opioid-Related Adverse Events
Tidsramme: Within the first 24 hours postoperative.
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Incidence of opioid-related complications, including postoperative hypoxemia.
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Within the first 24 hours postoperative.
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: yomna Emad Youssef, Ainshams University Hospitals
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Tegn og symptomer, fordøjelsessystemet
- Patologiske tilstande, tegn og symptomer
- Tegn og symptomer
- Opkastning
- Organiske kemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Azoler
- Kulbrinter
- Cyclohexanes
- Cycloparaffiner
- Kulbrinter, alicyklisk
- Kulbrinter, cyklisk
- Imidazoler
- Anilider
- Amider
- Anilinforbindelser
- Aminer
- Acetanilider
- Lidokain
- Dexmedetomidin
- Ketamin
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- FMASU MD320/2025
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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